Causes and management of shock

Shock is a frequently misused term, but when used to refer to cellular hypoperfusion it becomes the most recognizable cause of critical care admission. Successful management requires not only early recognition of onset, but also an understanding of the aetiology and underlying physiology. An important part of the treatment paradigm for shock is the developing concept of ‘care bundles’. These are protocols that recommend interventions, based on clinical evidence, designed to improve outcome. However, bundles often fail to promote the early use of appropriate monitoring, which should guide and assess the effects of therapeutic management and interventions. Manipulation of a monitored variable such as oxygen delivery has been shown to improve outcome in selected patients.